Arthroscopic Repair Or Double-bundle Anatomical Reconstruction With Semitendinosus Tendon For Chronic Lateral Ankle Instability

Purpose: The purpose of this study was to evaluate the functional outcome of a double-bundle anatomical reconstruction and repair with ankle arthroscopy,which was devised to treat chronic lateral ankle instability. Methods: This prospective study involved 48 patients(48 ankles) with chronic lateral ankle instability treated from 2008 to 2011, Median patient age at surgery was 37.4±13.2 years,which were randomly divided to group A and B. The technique involved direct repairation of ATFL/CFL for group A(double-anchor technology), and anatomic double-bundle reconstructions of ATFL/CFL with free semitendinosus tendon autograft for group B. Range of motion, AOFAS scores, VAS pain scores and patient subjective satisfaction were evaluated at median of 40.2 months(2-5years)postoperatively. Radiographically, talar tilt angles and anterior talar translation were assessed in pre- and postoperative ankle stress views. Simultaneously 20 cases ankle specimen of fresh cadaver were dissected to provide anatomic data for basis. Results: Median AOFAS score improved from 47.5+9.1 to 88.7+12.1 of group A(rate of excellent and good 87.5%) postoperatively 2 years follow-up, and 91.5+6.8 of group B(rate of excellent and good 95.83%)(P<0.05).There was no difference in pain, gait, hindfoot extension and flexion and alignment; but difference in walking on grand, maximum walking distance, autonomic activity and stability. About patient subjective satisfaction excellent and good rate of group A was 87.5%, group B 95.83%(P<0.05).Median VAS pain score decreased from 6.8+4.2 to 2.0+2.9(group A) and 2.05+1.7(group A). Talar tilt decreased from 11°(3-24°) to 3°(1-10°) and the mean anterior drawer test decreased from 10.0 mm(4-15) to 2.5 mm(2-6)(P<0.05). No complication was encountered such as subtalar stiffness or recurrent instability. No patient reported weakness or disability from the donor site. Conclusions Anatomic double-bundle reconstruction of ATFL/CFL with semitendinosus tendon and The modification of the Brostrom procedure was suitable for treating lateral ankle instability,but the former especially for young patients with high stability requirements, and the latter especially for older patients with Slightly lower stability requirements. Modified insicion and keeping remnant would contribute to good results. Long term follow-up was expected.